Outcomes and Resource Use Associated With Acute Respiratory Failure in Safety Net Hospitals Across the United States

Williamson, Catherine; Hadaya, Joseph; Mandelbaum, Ava; Verma, Arjun; Gandjian, Matthew; Rahimtoola, Rhea; Benharash, Peyman

doi:10.1016/j.chest.2021.02.018

Cited by 16 publications

(10 citation statements)

References 46 publications

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“…3À5 In the USA, ARF treatment cost exceeds $50 billion per year due to the high mortality and long LOS, especially for elderly patients. 6,7 Therefore, it is critical to find the causes among elderly patients with ARF to reduce the high mortality and long LOS, hence high medical costs.…”

Section: Introductionmentioning

confidence: 99%

The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study

et al. 2021

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Background: Elderly people with acute respiratory failure (ARF) have prolonged length of hospital stay (LOS) and high mortality rates. Malnutrition is negatively correlated with these LOS and mortality. However, no tools have been used to detect the risk of malnutrition and assist in designing nutritional support for these patients. The geriatric nutritional risk index (GNRI) is reported as a novel tool for evaluating the risk of malnutrition. The aim of this study is to explore the relationship of the GNRI score with mortality and LOS in elderly patients with ARF. Methods: Data of elderly patients diagnosed with ARF were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) database. A total of 1250 patients were divided into two groups based on their GNRI score: the malnutrition risk group (GNRI 98) and no risk group (GNRI > 98). The primary endpoints of this study were hospital mortality and hospital LOS. Results: The higher GNRI score was associated with lower hospital mortality and shorter hospital LOS. Odds ratio (OR) for hospital mortality of patients with nutritional risk (GNRI 98) was 1.264 (95% CI:1.067À1.497) in the adjusted model. Patients with GNRI 98 had longer hospital LOS (adjusted OR: 1.142, 95%CI: 1.044À1.250) compared with those with GNRI > 98. Subgroup analysis showed that higher GNRI was only significantly associated with lower hospital mortality in the patients that did not undergo mechanical ventilator (MV) treatment (adjusted OR: 0.985, 95% CI: 0.977À0.992, P < 0.01). Kaplan-Meier curve analysis showed that the 90-day survival was significantly lower in the group with nutrition risk (GNRI98) compared with the no risk group (GNRI > 98, p < 0.05). Conclusion: These findings imply that GNRI is a useful prognostic tool in elderly patients with ARF.

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Section: Introductionmentioning

confidence: 99%

The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study

et al. 2021

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“…IHCA survival largely depends on the quality of acute and post-resuscitation care, and hospitals with more resources tend to perform better (5,(22)(23)(24). High hospital safety-net burden have been associated with inferior outcomes across multiple clinical conditions due to limited resources (20,25).…”

Section: Discussionmentioning

confidence: 99%

“…For the final analysis, only HBH and LBH were included. This safetynet burden determination method has been previously used in similar studies evaluating hospital safety-net burden (18)(19)(20).…”

Section: Safety-net Burdenmentioning

confidence: 99%

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Olanipekun

Abe

Chris-Olaiya

et al. 2023

Critical Care Explorations

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IMPORTANCE: High safety-net burden hospitals (HBHs) treating large numbers of uninsured or Medicaid-insured patients have generally been linked to worse clinical outcomes. However, limited data exist on the impact of the hospitals’ safety-net burden on in-hospital cardiac arrest (IHCA) outcomes in the United States. OBJECTIVES: To compare the differences in survival to discharge, routine discharge home, and healthcare resource utilization between patients at HBH with those treated at low safety-net burden hospital (LBH). DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study across hospitals in the United States: Hospitalized patients greater than or equal to 18 years that underwent cardiopulmonary resuscitation (CPR) between 2008 and 2018 identified from the Nationwide Inpatient Database. Data analysis was conducted in January 2022. EXPOSURE: IHCA. MAIN OUTCOMES AND MEASURES: The primary outcome is survival to hospital discharge. Other outcomes are routine discharge home among survivors, length of hospital stay, and total hospitalization cost RESULTS: From 2008 to 2018, an estimated 555,016 patients were hospitalized with IHCA, of which 19.2% occurred at LBH and 55.2% at HBH. Compared with LBH, patients at HBH were younger (62 ± 20 yr vs 67 ± 17 yr) and predominantly in the lowest median household income (< 25th percentile). In multivariate analysis, HBH was associated with lower chances of survival to hospital discharge (adjusted odds ratio [aOR], 0.88; 95% CI, 0.85–0.96) and lower odds of routine discharge (aOR, 0.6; 95% CI, 0.47–0.75), compared with LBH. In addition, IHCA patients at publicly owned hospitals and those with medium and large hospital bed size were less likely to survive to hospital discharge, while patients with median household income greater than 25th percentile had better odds of hospital survival. CONCLUSIONS AND RELEVANCE: Our study suggests that patients who experience IHCA at HBH may have lower rates and odds of in-hospital survival and are less likely to be routinely discharged home after CPR. Median household income and hospital-level characteristics appear to contribute to survival.

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“…All subjects were further stratified according to the type of prosthesis received (mechanical versus bioprosthetic). Hospitals were grouped into quartiles based on the proportion of all admissions classified as underinsured (Medicaid or self-pay), with the highest quartile considered safety net hospitals (SNHs) and the remainder as non-SNH [ 14 ]. Definitions of self-pay were determined using the HCUP data elements and encompass those who are uninsured and ineligible for government assistance [ 13 ].…”

Section: Methodsmentioning

confidence: 99%

Utilization of mechanical prostheses and outcomes of surgical aortic valve replacement at safety net hospitals

Kim

Tran

Xia

et al. 2022

Surgery Open Science

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Outcomes and Resource Use Associated With Acute Respiratory Failure in Safety Net Hospitals Across the United States

Cited by 16 publications

References 46 publications

The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study

The relationship of the geriatric nutritional risk index to mortality and length of stay in elderly patients with acute respiratory failure: A retrospective cohort study

Impact of Hospital Safety-Net Burden on Outcomes of In-Hospital Cardiac Arrest in the United States

Utilization of mechanical prostheses and outcomes of surgical aortic valve replacement at safety net hospitals

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